Michael Krikheli
Co-Founder & CTO of Five Sigma
Michael leads the development of advanced claims management products powered by data, analytics, and AI. With over a decade of experience in software engineering and team leadership, Michael excels in designing, building, and scaling innovative technologies that solve complex, real-world challenges.
5 MINUTE READ
In my day-to-day work as a Chief Technology Officer of a leading insurtech, I get a ton of help from my assistants, John and Alex. John is the one helping me with everything on my calendar. He’ll take a look at it in the morning, check if there are any double bookings, see if there’s any context missing before one of the meetings, make sure he understands the details and goals of each meeting, and then provide me with a brief for the day.
When something urgent happens during my day (which is practically every day), I ask John to move the schedule around and fix everything – reshuffling meetings, updating participants, and always doing it in a way that reflects my priorities, ensuring nothing falls through the cracks.
Sometimes Alex gets in the picture. When John needs to send a cancellation email or push a meeting, Alex handles it. He’s the king of my email — reading every new message as it comes in, assessing its priority, drafting a response, and sending it when he’s confident it’s the right one. If he isn’t sure, he prompts me to handle it directly. He collaborates with John to make sure that my schedule is tight, and everyone is informed about what needs to be done before each meeting.
John and Alex are AI agents, working together to make my work life better.
Insurance Claims Can Benefit from AI Agents
A lot of you would believe that John and Alex are not only possible, but already exist (or will exist in the very immediate future). You’re not wrong.
These kinds of AI assistants are becoming part of everyday life. And yet, when it comes to claims handling in insurance companies, we’re still far behind.
But why should insurance claims management be far behind?
What’s the real difference between me using AI agents on my email and calendar, and a claims adjuster trying to coordinate the details of a claim? What differentiates my personal productivity stack from a global, regulated insurance operation?
The answer is: A lot, but also, not that much.
Yes, the scale, detail, and volume of information handled by a global enterprise like a large insurer is far greater than my singular work schedule. But the reality is that claims adjusters deal with something even more structured than my schedule and inbox. They follow their insurance companies’ Standard Operating Procedures (SOPs). They operate within the boundaries of compliance rules. They have repeatable patterns. They handle tasks that, if modeled correctly, don’t require constant human intervention. But unlike me, they don’t have John and Alex.
Yet.
Claims Management Systems are Ready for AI Agents
Here’s what I believe: 2025 is the year when insurance claims management systems (CMS) begin to fully support AI agents – not as gimmicks or limited point solutions, but as operational collaborators.
We’re going to see agents that understand the context of a claim, just like John understands my calendar. We’ll meet AI agents that know when information is missing, when follow-ups are due, when the reserve hasn’t been recalculated, or when a vendor needs to be selected based on policy conditions and coverage rules.
These AI agents will connect to the CMS. They’ll be aware of the regulatory framework, the business model, the company’s internal workflows, and the claim’s timeline. And more importantly, they’ll be helpful – orchestrating an entire claim and advancing it automatically, with minimal or no human involvement.
AI agents will make decisions where confidence is high. And they’ll flag decisions for review when needed. They’ll write communications. They’ll take action to move the claim forward, and in the background, they’ll document everything for audit and compliance.
This is automation that lets adjusters focus on their unique professional purpose — judgment, empathy, strategy.
Claims AI Agents Will Redefine Adjusters’ Relationship with Work
Think about what it means for the claims teams. If every adjuster had access to their own John and Alex — AI agents who know their portfolio, understand their queue, track every open task — that’s a shift. Adjusters no longer have to chase details or carry the entire claim in their heads. With AI agents by their side, they can operate with focus, confidence, and space to think. That’s the difference. And that’s why this shift matters.
And just like my AI agents work together — with John coordinating the calendar and Alex taking care of communications — we’ll see the same coordination in claims.
One AI agent tracks data inputs and identifies gaps. Another AI agent creates action items. Another agent handles documentation. Another agent oversees communication. And all of them feed off each other. They’re not one monolithic system. They’re a team of AI agents.
This shift changes more than just workflows. It reshapes the relationship between adjusters and their work. When AI agents handle the time-consuming, manual load, adjusters can actually accomplish more in less time. They can finish their quota, settle more claims, and leave work with a sense of completion rather than backlog. They go home knowing they made a difference, and not just shuffled papers.
That feeling of success, of doing real adjustment work that matters, is what’s missing. And that’s what we’re creating with our technology at Five Sigma.
Meet Clive™, the Insurance Industry’s First AI Claims Adjuster
At Five Sigma, we built Clive to be that AI agent, or better yet, that team of AI agents. Clive is an operational layer on top of your existing claims management system. He reads data, checks SOPs, understands rules, and proposes what needs to happen next. He can also take action on his own based on permissions, or ask for approval when needed.
Clive is our way to bring this AI agentic world to life and to any claims organization.
Clive is trained on vast amounts of real-world claims data, policy language, regulatory knowledge, and industry best practices. He brings insurance-specific judgment to every recommendation, with an understanding of the nuances and constraints of actual claims handling. This includes compliance requirements, jurisdictional differences, and how human adjusters make decisions in the field.
Clive works alongside adjusters, saving them a lot of time. Adjusters who work with Clive handle claims faster and better, and enjoy more meaningful work.
Clive ensures that the modern world of helpful AI agents becomes an everyday reality for claims teams too.
